Managing fungating wounds can be challenging for nurses, especially in terms of implications for patients and of quality of care. These wounds can spread rapidly, either as a primary, metastatic or recurrent malignancy, and are often associated with breast cancer. 

The physical and psychological impact of the wound on day to day living can be enormous, with subsequent quality of life issues. Malodour, offensive exudate, pain and discomfort, infection, and bleeding are some of the problems experienced by patients. Oozing wounds cause anxiety about seepage. They can prevent women from wearing feminine clothes and they can effect some people's need for physical closeness and sexual activity. Holistic psychosocial support of patients and families is required along with physical care.

Some nurses have experience in the management of these types of wounds but others may have to seek expert help. This help may come from specialist palliative care nurses or from wound management specialists. Effective wound assessment, use of appropriate dressings and symptom management are vital.

Resources

• End of Life / Palliative Education Resource Centre (EPERC) Fast Facts: Malignant Wounds
• Fact sheet from the British Columbia Cancer Agency: Ulcerating Malignant Skin Lesions 
• Gloucestershire NHS Primary Care Trust (UK) has a policy on the Management of Fungating Wounds (2007)
• This presentation on 'Management of the Smelly Wound’ has been modified for the SA Society for Vascular Nursing (2010) from the original by La Trobe Podiatry students (2005). NB The recommendations (such as for medications and dressings) are those of the author and for local use. Please check with the treating team before instigating any changes.

Related CareSearch Pages

Nurses Hub
Communication
Complementary Therapies
Symptom Management

CareSearch Review Collection
Skin wounds

Free full text article

Naylor W. Part 1: Symptom control in the management of fungating wounds. World Wide Wounds. 2002 Feb.

References 

• Alexander S. Malignant fungating wounds: managing pain, bleeding and psychosocial issues. J Wound Care. 2009 Oct;18(10):418-25.
• Alexander S. Malignant fungating wounds: managing malodour and exudate. J Wound Care. 2009 Sep;18(9):374-82.
• Alexander S. Malignant fungating wounds: key symptoms and psychosocial issues. J Wound Care. 2009 Aug;18(8):325-9.
• Alexander S. Malignant fungating wounds: epidemiology, aetiology, presentation and assessment. J Wound Care. 2009 Jul;18(7):273-4, 276-8, 280.
• Seaman S. Management of malignant fungating wounds in advanced cancer. Semin Oncol Nurs. 2006 Aug;22(3):185-93.
• Lund-Nielsen B, Müller K, Adamsen L. Malignant wounds in women with breast cancer: feminine and sexual perspectives. J Clin Nurs. 2005 Jan;14(1):56-64.
• Burns J, Stephens M. Palliative Wound Management: the use of glycerine hydrogel. Br J Nurs. 2003 Mar;12(6 Suppl):S14-8.

This page was created on 27 August 2010
Last updated on 27 August 2010*